Individual
STACIE DESHANNON COOPER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
10169 MANZANILLA AVE, DALLAS, TX 75217-1267
(469) 992-4246
Mailing address
10169 MANZANILLA AVE, DALLAS, TX 75217-1267
(469) 992-4246
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
MT106974
TX
Other
Enumeration date
04/15/2024
Last updated
04/15/2024
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